wrist fracture in Tunisia

Wrist Anatomy

The distal radius is the largest supporting bone of the wrist. All bones in the wrist are important for function and their shape and position must be perfect to allow full range of motion of the wrist. The distal radius has a cartilage joint surface that helps the wrist joint glide smoothly. If this becomes irregular, wrist arthritis can occur.

Non-Surgical Treatment of Wrist Fracture

Wrist fractures do not always require surgery. Many heal very well without surgery. Minor fractures with minimal displacement work very well with non-surgical treatment. Other displaced fractures can be "reduced" and casted. This means the doctor can put the bones back in place. Initially, splints are placed in the emergency room and converted to casts in the orthopedic office. If non-operative care is chosen, regular follow-up care for physical examination and X-rays is important to ensure the fracture remains in good position and heals appropriately. Reducing or stopping smoking and closely controlling blood sugar if you are diabetic is important for the healing process. If the bones lose their alignment or slip, surgery may be necessary. Wrist fractures treated non-operatively are typically casted for 6 weeks. The cast is then removed, patients receive a removable wrist splint, and physical therapy is initiated to help patients regain their range of motion.

Surgical Alternatives for Wrist Fracture

Surgeons may recommend surgery to repair the broken wrist if it is broken into multiple pieces, if the bones are far apart, if the joint is uneven, if the bone is protruding through the skin, or if nerves or blood vessels are injured. Several studies have shown that surgery helps reduce pain, gets people back to work sooner, and maintains shoulder strength and movement.
Distal radius fractures can be fixed with plates and screws or pins. Plates and screws require larger incisions but ensure the bone is perfectly aligned. Pins use smaller incisions and are typically used for less severe injuries or in children with wrist fractures. Surgery takes less than an hour and can often be performed on an "same day" or outpatient basis. Ideally, surgeons like to perform surgery within 1-2 weeks of the injury. This gives patients time to seek a second opinion regarding treatment if more information or additional feedback from the surgeon is desired.
In cases where there is severe injury to muscles, nerves, or arteries or if there is significant contamination from dirt, rocks, or grass from the injury, some patients require external fixation before definitive surgical treatment. This is an operation where metal pins are placed in the bone through small cuts and connected to bars to give some stability to the bone. After secondary operations to clean the wound or recover from skin injuries, the external fixator can be removed and plates and screws can be placed.
It is important to choose your surgeon carefully. Extensive surgical experience can be helpful in achieving a good outcome and avoiding complications. Collectively, ROC trauma and hand orthopedic surgeons have performed more wrist surgeries than any practice in northern Nevada and are proud of exceptional surgical outcomes.
After surgery, patients are placed in a splint and given a sling for their comfort only. Weight-bearing is limited to a few pounds but patients have free fingers for typing and performing gentle activities. Within 10 to 14 days, the splint is removed, a removable brace is used, and initial range of motion exercises are encouraged. Some patients are referred to physical and occupational therapy to help with stiffness, strengthening, and movement.

Surgical Complications

Complications can occur with any surgery, no matter how small. There is always a risk of infection. A dose of antibiotics given before surgery helps minimize this risk. There is always a risk of injury to blood vessels or nerves. This is reduced by having an experienced surgeon involved in your care. It is always possible that a broken wrist may not heal. This is usually associated with patient non-compliance, diabetes, or use of nicotine such as smoking and chewing tobacco. If this occurs, secondary surgery may be necessary. A rare complication of distal radius fractures is reflex sympathetic dystrophy (RSD) or complex regional pain syndrome (CRPS). This is a condition where patients develop persistent pain and hypersensitivity. This can be treated with physical therapy, nerve blocks, and medications.

Outcomes

Most people with wrist fractures do very well. After 6 weeks, patients are extremely comfortable and are typically released to their full activities like manual labor, skiing, and motocross after 3 months. An aggressive return to activity too early can lead to re-fracture, hardware failure, or non-union. If you have had surgery, the metal sometimes becomes painful. This can be removed one year after surgery.